Things that keep me sane right now

I can't remember the last time that I didn't have something to do. I would guess that it was the summer between grade 10 and grade 11, about eleven years ago. Even then, I babysat more days than I didn't, and worked at gymnastics camp, so if we're really looking back, the last time I had this long a break would have to be when I was about twelve.

It's been two whole weeks of unemployment. It's definitely a BIG change for me.

I started school when I was five, I did the normal kindergarten to grade 12. I worked the summer between grade 12 and university, and for the next four years I worked/took classes/went to practicum and worked over the summer. I started my first "real" job the day after my graduation. Each time I've switched jobs I've taken less than a week to make the transition. Now, I'm finally having a real and true break. It's weird.

The first week was kind of nice, I babysat a couple of times, had a couple of appointments, kept myself busy. Last week was a little harder, but for the most part, I found a daily activity, something to get me out of the house, this upcoming week, who knows. But, there are some things keeping me sane, and so, in typical me fashion, I close this post with, a list.

Things that keep me sane right now:
- setting my alarm clock
- having a reason to get up each day (without one, I just don't get up)
- the alarm clock on my coffee maker
- daily yoga practice
- the gym
- my friends
- getting out EVERY day
- planning ahead, so there's always something to fill my time
- being nice to myself
- taking things slow
- daily job search
- eating
- sleeping at night

and I'm sure many other things, but that's it for now!

awkward questions/compliments

Something I talk about in the classes I teach on Assertiveness, Self Esteem and Criticism, is that a lot of people have a hard time accepting compliments. So often in life, we are unable to take compliments at face value, and we have a hard time accepting them as positive. Sometimes it is because we are wondering about a hidden motive, what does this person want? Why are they being nice to me? Other times, it is because we don't believe it ourselves, when we feel badly about ourselves, it's hard to imagine that others don't feel similarly. I'm sure the following conversation is fairly normal in your life as well.

"Nice outfit today!"

"Oh, this old thing, I found it in the back of my closet"

"You did a good job on that project!"

"(list of all the things that went wrong on the project)"

Because I am constantly teaching this, I've tried really hard to work on it myself, and I really think I've improved at taking compliments, except about one issue. See, here's the thing, in January, I did a detox at yoga, and after that, my naturopath put me on an asthma nutrition plan which cut out eggs, wheat, dairy, chocolate, wine and beer. So, since January, I've lost more than 40lbs. I am still not even half way to being a "healthy" weight for my height, but it's a big change, and it's quite noticeable now. I have a really hard time with this. Part of the problem is that I was happy with my body the way it was before, and I'm happy with my body the way it is now. I'm enjoying the weight loss because it's been good for my yoga practice, and I'm almost out of plus sizes so the thrift store will have more clothes that fit me... oh, and towels wrap around me better! I am not, however, obsessed with the weight loss. I stick with the eating plan because it has helped my asthma A LOT. I've cut back a huge amount on the inhaled steroids, from two puffs, twice a day to one, once a day, and the only time I have asthma symptoms is when I eat things that aren't on the plan, (like the s'mores last weekend!)

How does this relate to compliments? Well, I've started getting a lot of "compliments" on my weight loss. And I'm really having a hard time with it. I've been trying to get to the root of why, but I'm having a difficult time analyzing it. Part of it, I think, is that it seems too personal, but my body is something the world sees everyday, of course my coworkers and friends will notice the change in size. If I get a new hair cut, or new makeup, they notice, why wouldn't they notice this. Then there is a part of me that feels that I don't deserve the compliment, that I haven't done this to lose weight, that I'm not cutting calories that much (I eat a lot of tortilla chips and jelly bellies). The simple fact is, that with cutting out eggs, wheat and dairy, and continuing with my yoga classes, I must be eating less than I put out. I've had to eliminate frozen pizza and ice cream and lean cusine frozen dinners from my daily eating, and it makes a big difference. I also had to stop eating most desserts and snack food. So, I feel like I'm not putting nearly as much effort into this, in a direct way, as all the times I did try and lose weight and failed.

So really, I think the issues comes down to the weight. I don't like that the focus is on weight. I don't like that it's something we compliment people on, and yet in some ways, I think we should? I have a lot of thoughts about it, and I'm having a hard time getting them out. On the no side, as in no, we shouldn't compliment people about their weight loss, my thoughts are as follows.

- Self Esteem and Self Worth should not come from physical image or outside things. Giving compliments about this does not promote internal factors.

- My sister has an eating disorder, as do many, many others, and this is a huge trigger thing.

Then there's my thoughts on the we should compliment people side of things.

- Science has shown us over and over that obesity is rampant, and a huge cause of health programs, should we not applaud people's efforts to be healthy?

- (This goes with the one above, I suppose) if someone were to quit smoking, we would applaud it, if they were to quit drinking, we'd compliment them, why wouldn't we do the same to weight loss?

I think what it comes down to, is who the compliments come from, and how their phrased, at least in my book. For example, when my supervisor compliments me, she says things like "you've really changed a lot of your habits" and she encourages me in my healthy eating. When her supervisor compliments me, she says things like "you're a lot smaller, have you lost weight?" I find the questions harder than the compliments, I suppose. People telling me I look good, I don't seem to mind nearly as much as people telling me I look good I because I've lost weight, or that the weight loss looks good. I have a really hard time with those, and I question, did I look that bad before? I was okay how I looked then to! (I also really hate it when anyone calls me a skinny minny, or really, when anyone uses the word "skinny".

I suppose, this has no conclusion. I haven't answered any of my questions. I still don't know whether it's good or bad to compliment someone on their weight loss (thankfully I'm so oblivious I never notice when someone loses or gains weight, so that part of things is not an issue for me), and I still don't know why it bothers me so much when people compliment me on my weight loss. Thoughts for another day, I suppose.

Defining Normal

I was thinking today about what makes something "normal". What makes a behaviour normal, what pushes it over the line into abnormal? What makes a state of mind normal, and when does it become a problem? Who gets to decide what normal is?

A little background, this issue came to mind as I was thinking about my reactions to some current stresses in my life with moving, home ownership, friends, and work. I'm perhaps particularly sensitive towards my reactions in light of the negative reaction of the insurance company towards my anxiety. Either way, as I stood in my shower crying, I asked myself, "is this normal?" I decided that it was, and that I am indeed having a healthy reaction towards stressful events in my life, but it got me thinking about how often I "make" that decision for other people as well.

Working as a counsellor, I have a many, many clients who worry that they are not "normal", or in fact, label themselves as "crazy" and/or "nut jobs". As a general rule I am quick to reassure people that are "normal" and are not in fact "crazy", and I'm not sure I've ever really thought about what a enormous power that is. I tend not even to think about it, my instant reaction when someone tells me they're "crazy" is to defend them to themselves. I'm not proud of this reaction. I think perhaps a more helpful response and one I already do to some extent use, but should probably use more, is to explore what is going on for the person at that moment. What has led them to wonder if they are crazy, how might they describe similar behaviours/thoughts in someone else etc... Because really, do I know what normal is? I have a fairly good understanding that somethings are "not normal". For example, spending hours starring at a flag pole waiting to see if you can catch a glimpse of the wind is not generally considered mentally healthy, especially when the police have to remove you from said flagpole for your own safety. Spending more of your day in tears than out of tears is also not generally considered normal or healthy. The same goes for hearing voices, running through the streets naked, binge eating and then purging or a whole host of other behaviours.

The behaviours I just talked about definitely fall more on the "not normal" side of things. But what about things like being anxious about a job interview? Perfectly normal, right? But what about when that anxiety makes it impossible for you to attend the interview and leaves you shaking in your bed? Not so normal anymore, right? Crying every day for two weeks might be considered a sign of depression, or a perfectly normal response to the death of a close friend or relative.

I wonder if perhaps a better way to address the question of whether a person is "normal" or not, is to explore the issue further with them, and then to provide information. I think I do this, and maybe could do more of this. So for the person who asks me if crying every day for two weeks is normal, we would explore what had started this, what had happened before hand, what was triggering it etc... I can provide information about the symptoms of depression, or reactions to grief etc... This then could be normalizing, without coming out and using my power as the counsellor to declare someone normal or not normal. Because regardless of my intention and effort to label as a behaviour, there would always be the risk that this was taken as a judge of the whole person.

I still have SO much more to say about this, but for tonight, this is all my eyes can stay open for. Stay tuned for next time when I look at whether "we" even want to be normal!

stigma of mental illness

I really want to start blogging again. I keep trying, but it never seems to last for long. I'm going to give it a go again though.

I've been thinking about the stigma of mental illness the past couple of days. It's something we talk to our clients about when do data collection and statistics (do you feel stigmatized in the community) but I've never really though of it in my own context. Up until yesterday, I had never felt stigmatized, or at least never identified any feelings as being feelings of stigma. However, the reason I have never felt stigmatized is because I don't exactly talk about my mental illness on a regular basis. My anxiety has always been a fairly private thing for me. Although people I am close to know that it is something I deal with and that I take medications for it and have gone to counselling, it's not something I talk about as being currently present in my life on a regular basis. Although, for the most part, it's under control, so maybe that is a part of it. In any case, it's not something I talk about with my coworkers or acquaintances, thus, no stigma.

That brings me to now. And why I've suddenly become more awakened to the realities of stigma and mental illness. I recently bought a house (it's all mine in only 45 days!!!) When I signed my mortgage at the bank, I applied for mortgage insurance - life, health crisis, and disability. Two different companies underwrite the policies and I had to have a very in-depth phone interview with each of them. They asked me about each and every little thing that could possibly be wrong with me, plus about my family history of things. Now, because I have asthma and have a family history of cancer and heart disease I figured I would not qualify, oh, and I'm overweight. However, it never even occurred to me that I would get a letter stating you do not qualify for our insurance because of your history of anxiety.

I was angry. Very angry. I have NEVER let my anxiety get in the way of me doing what I need to do. Never missed a day of work, never missed a day of school, I've never been hospitalized, or been to the hospital because of my anxiety. But there it was, in black letters telling me that I didn't qualify for something because I was mentally ill. I'd never put that in the context of my self before. Never let the anxiety stop me from something. I'm having to integrate this into my understanding of self, that because of the anxiety, there are some things that I simply cannot have. And I don't like it.

Having this experience though, I hope, will help me grow. I happened to see my counsellor yesterday and she reminded me that TONS of people go on disability for stress related illness and so it kind of made sense that a history of anxiety would disqualify me from disability insurance (I still haven't got the results back on the life insurance). I am reminded, that for my clients, who have mental illness which affects their ability to work, there may often be much more of a stigma. It reminds me to, that I really do need to pay more attention to opportunities to fight stigma and be involved in more public education both on a small and a large level. I also need to decide if I want to appeal this decision, or make a bigger issue out of it, or just be passive, accept the decision and move on from here.

It's been awhile, so I thought I'd post another update. Life continues. Mom is having surgery on Monday which will hopefully be reaaaaally good for her. I've been working on using up my holiday days (which have to be gone by March 31st) as well as my sick days (same deal) while earning extra money working at the shelter. Over all, I'm actually doing quite well and I'm feeling like things have worked themselves into a new balance.

I worked at the shelter two days this weekend. There is something SO freeing about not having a caseload and something incredibly freeing about not having voice-mail. I am in LOVE with not having voice-mail! Seriously, I too Thursday off and I came back to EIGHT new voice-mails. Seriously people, if you leave ONE voice-mail, I promise I will get back to you. When you leave me THREE, it makes me not want to call you. (That being said, I'll still call you).

I love working at the shelter. I love my counselling job too, but I really really like hanging out with the homeless. As my long time readers will remember there are a lot of good reasons why I don't work at the shelter full time, but every now and then I get nostalgic for it. There's just something so very real about it, and I feel like I am really able to impact people. That being said, in terms of measurable change, I make a far greater difference at my other job. But, measurements, smeasurements.

counselling

I had a super intense session with someone today. We had a really intense one last week too. I don't know if the client finds things as intense as I do, but I feel like we're really hitting the root of some incredibly deep pain.

I've been thinking about how to assess the effectiveness of what I do. For our job developers it's a lot easier. Either people get jobs, or they don't. Plain and simple. They can count the number of people they help find employment each month. It's A LOT harder for the counsellors. I mean, I can count the time I spend in sessions with people, and in fact, I'm required to. But how do I judge whether what I do has a positive affect on people?

One thing that helps is when clients volunteer that feedback, but it doesn't always happen. For example, I wonder if I'm actually helping the client I saw today. They're dealing with some very intense stuff, and I have no idea whether our work together is helping, but there doesn't seem to be an appropriate way to ask... Counselling is a very abstract thing to measure.

In other thoughts, I wonder if an empty chair exercise would be helpful or hurtful to someone with schizophrenia. I mean, of course it depends on the person, but in general... There's a client I think it would really benifit, but I don't want to play into anything they may have going on for them... I need to do some research on Gestalt Therapy and Psychotic Disorders...

craaaaaay week

It is amazing to me, that one of my clients could ingest more than 200 pills, wind up at the hospital in an ambulance, be treated in emergency and be released with no admission, not even a follow up. The day before that they refused to admit her to psych. Who knows what the weekend will bring. Apparently she is safe because she swallowed her plan.

For the record, my whole week's been like this. I spent all of Thursday in tears. It's a long story. But every six months or so, I cry for an entire day. Unfortunately, that day, was Thursday. It sucked. But, it turned out really well. My supervisor and I had a great talk (after she freaked out at me in the hallway earlier that day). I'm calling in sick Monday for a planned mental health/self care day.

Also, Oliver Lockhart seems to think the litter box will attack him. It's a closed box, (with a lid) and he does his business with his head sticking out. After he burys it, he BOLTS down the hall to the living room like there's something chasing him. It is hilarious! Just thought I'd share :)

rant around the clock

I'm having an issue at work that I'm kind of getting sick of. My clients seem to have a VERY difficult time keeping their appointments. Now, I don't mind the occasional missed appointment that was forgotten about, and I of course don't mind rescheduling with notice, but this is getting ridiculous. It bothers me on a number of levels, and I'm not really sure what the reason behind things is.

Now it is true that my client population is dealing with mental heath concerns, this can definitely affect memory and sense of time. However, everyone who gets into my program has to be fairly stable. We're not usually working with people who are actively psychotic (although of course it happens every now and again). So this could be one reason.

Now the other reason that my coworkers and I have discussed is that we are a free center and there is no consequence for missed appointments. If a client misses an appointment, nothing bad happens. We reschedule. That's it. It's not something they're paying for, and maybe that gives it less value? Perhaps because there are no consequences when something else comes up or they don't feel like coming in, they don't.

My program still uses the Psychosocial Recovery Model (PSR Model) which, although old, has some value. There is a huge emphasis on client responsibility and client decision making and empowerment (which are great) but it also means that we don't chase after our clients as a general rule. We don't require them to come to appointments, it's their choice.

I think what frustrates me, is that I put aside time in my day for a client, that I could give to another client or use for my never ending pile of documentation. Instead, I'm left wondering whether they'll come in or not. For many clients, I do prep work and it's frustrating when they're a no show. It also bugs me on a personal level (as opposed to professional) that I managed to show up for all my therapy session when I was in therapy, why can't they, but that's not something that's all that relevant really.

So that's my rant for the day. I'm SICK of it. But, life will go on, mine, and theirs.

Hearing Voices - Workshop

Last week I went to a fascinating workshop called "Hearing Voices that are Distressing". It's based on the idea that a person can experience hearing voices, as someone with schizophrenia might, the same way a person can experience a physical disability by being in a wheelchair for a day.

The first part of the workshop was general discussion/information about schizophrenia/psychosis and the organization which held the workshop. Next though, was the really interesting part.

Each person put on a pair of headphones and pressed play on a tape. The tape mimiced the voices that the workshop creator has experienced in her life. Then we were put through a mock psych assessment at a contrived psychiatric hospital. We had to do a mini mental status exam, a cognitive assessment and a reading comprehension test. The "staff" (workshop leadership) behaved in a very cold and clinical (old school clinical) way. We also had to go on a "errand" out in the community and write down some information, all while wearing the headphones and hearing the voices. I was definitely a one of a kind experience.

I found that all I wanted to do was sit down and listen to the voices. I didn't want to do any of the other stuff at all, for me, it really opened my eyes to why someone hearing voices might isolate themselves. Other people found themselves listening to the directions of the voices (stop it, put your hands down etc...) while others found themselves very frightened and frustrated. And we all knew that the voices were a tape!

Afterwards there was a debrief time, and even though I'm normally a very talkative person all I wanted to do was go home and rest. I felt soooooo over stimulated. Of course I had to work though, and go to a goodbye party...

Overall, it was a great workshop, and if you ever have the chance to do something similar I would highly recommend it!

it's a lot easier

Lesson of the week: Sometimes it is WAY easier to be a social worker than a friend.

One of dearest and most beloved friends is currently dealing with extremely debilitating anxiety. If she was a client, I would know what to do, but it's so much harder to be a friend. That comes across sounding wrong somehow. I'm not sure it expresses what I'm truly trying to say. Let me try again.

I'm not trying to say that I want to be my friend's social worker, because I very much do not. What I am trying to say is that as a social worker, I have techniques and boundaries, and coworkers to debrief with, and time limited situations etc... Very rarely, does the emotional pain of my clients deeply hurt my heart. This is a good thing. It's what keeps me sane, and what enables me to be good at my job.

When my bestest bud is hurting, it breaks my heart. I hurt with her, and I hurt for her. I want to make all her pain go away. I certainly don't want to throw the responsibility back on her, I just want to fix the situation, so she doesn't have to deal with it. And I know she feels the same way, when I'm in the depths of depression (we've talked about it). Friendship is so deep on such a mutual level.

As social workers, we are able to make amazing differences in people's lives, we connect with people on a deep emotional level, but it's their emotional level, most of the time. We still have that inner running social worker dialogue going on in our heads. When it's our friends that are hurting, there's something else there.

This seems to be one of my more rambling posts, I haven't slept the greatest the past two nights, and I'm trying to express so much in this, and it's just not working.

On a positive note, because I like to end on a positive note, I got a BIKE! My last two were stolen, but hopefully this years bike, complete with even BIGGER lock, will last longer. That's the goal at least... In anycase, I'm riding to work tomorrow, and I'm very happy about that. SO glad to leave the car behind! Oh, and I made a pasta salad for lunch tomorrow, I'm very proud of myself.

and that folks, is a rare picture of the mess inside the dreamers house.

disclosure

Something that was drilled into us during school was the idea that you can't take a client further than you've gone yourself. In otherwords, deal with your own crap before you try and help people deal with there's. If you can't bear to face your childhood, how can you help your clients do so etc... Well, that teaching has been in my mind a lot lately, and here's why.

Working in employment we talk a lot about "disclosure". For my clients, this would mean choosing to disclose to their bosses, supervisors, human resources (whoever) that they have a mental illness. I find that some of our staff, one in particular, really look down on the clients who refuse to disclose, even when they're having problems. In some cases, they'd rather look for a new job. And some of our staff just can't comprehend why a client would feel this way. I totally get it.

See something I've been thinking about a lot since this topic started coming up at work is disclosing my own mental illness, and if I did, who would I "disclose" to, and what would that look like. Actually, I'm not a fan of the word disclose as it really implys something hidden. I kind of prefer to see anxiety as a part of me, and just as I wouldn't share intimate experiences at the work place, I don't share about my experiences of anxiety. Lately though, things have been sucking. They had been going quite well for a while, but then the seasons changed again, from spring to summer, and things haven't been going so well (i'd love to know what it is about the change in seasons that sets me off).

When in comes to the idea of talking to my supervisor about my anxiety, I'm not actually that nervous, I'm just not sure I see a point. One of the objectives of disclosure is to make accomidations, and right now I certainly don't need accomadations. On the other hand, if I was my supervisor, I might like some advanced warning in case things came up and I did need some accomadations. So I can see both sides. I think I'd also feel better around my coworkers if I could say something like, "my anxiety is really bad right now, so I'm going to shut my door and take it easy for half an hour and see how I'm doing". It would be reassuring and less isolating. On the other hand, on our team of 8 there is 1 person I would NOT want to know, and that makes disclosing to the team quite hard.

So in terms of clients. I'm realizing that this is an issue that will be close to my heart if it comes up in counselling. I fully believe I am capable of helping a client through it, I'm not giving the client advice or an opinion afterwards, but even in the questions I ask, and the direction I choose to go with the client, I'll have to be quite careful.

Any thoughts on disclosing mental illness in the workplace? Is it good? Bad? Neither?

What I'm reading this week: Confidentiality in mental health

Cordless, C. (Ed.). (2001). Confidentiality in mental health. London. Jessica Kingsley Publishers.

One thing of note when reviewing an edited volume is that each article is not equally good or equally relevant to one’s interests.  This book for example had some articles which related more to psychiatry or hospital based care than to the community based work I’m involved in. 

An ongoing theme throughout the book is the shift from a psychiatry/hospital oriented model of mental health care to a community based one and it’s implications confidentiality.  While in the past, patients may have engaged in individual psychoanalysis with one professional, many clients today are involved with interdisciplinary or interagency teams and their personal information may be shared with all members of the team.  Also, in the modern context we place emphasis on supervision, debriefing and consultation with colleagues.  While most of us as professionals would not perceive this as a breach of confidentiality, clients might. 

Another theme in the book is client expectations of confidentiality, informed consent, and whether clients really know what they are getting into.  While a client may be informed that their social worker works as part of a team, do they understand that this may mean common record keeping, or in the case of Assertive Community Treatment, a daily review of their file by the entire team. 

Finally, the book discusses the legal aspects of confidentiality and what constitutes a breach.  When does the threat of harm to others outweigh a clinician’s responsibility to keep confidentiality?  For many, it can be a “damned if you do, damned if you don’t” scenario as they face threat of litigation from both sides. 

I actually liked this book.  I didn’t read all of the legal chapters, but the chapter about social work was particularly good (or perhaps particularly relevant). The only draw back to the book was that it was British not Canadian and so all laws sighted were British.  I’d love to see Canadian authors pull together something similar.

 

Housing Part Four: Barriers to Safe Housing

So now that I’ve written about kinds of housing, reason people need housing, and what safe housing looks like, it’s only fitting to consider some of the barriers to safe housing.  Why, in an industrialized nation such as Canada doesn’t everyone have safe housing?? 

Numbers

The fact is, where I live, there number of people in need of safe housing simply outweigh the number of units available.  I live in a city with an extremely low vacancy rate, and that rate is spread through all levels of housing.  If we were to measure the number of people living in substandard, crowded and unsafe housing and compare it to the current vacancy rate the difference would be staggering.  There just isn’t enough housing. 

Money

When you rent an apartment, there is more to think about then just the cost of rent.  There’s also the damage deposit, and this is a big one.  Almost always, no damage deposit means no rental, and in some cases you are expected to put down first and last month’s rent as well.  This can be simply unreachable for people living on fixed incomes, and since you don’t get your last damage deposit back till you move out… Oh, and did I mention that it is impossible to rent an apartment one what our social assistance system pays for a single persons rent, let alone a safe one? 

Poor Rental History/Bad References

Once you develop a spotty rental history, it’s really hard to get away from it.  I actually had a client turned down as soon as the caretaker saw his name, he’d heard rumors about him in the area and wasn’t willing to risk it.  For someone trying to turn their life around, it can be really frustrating to get shot down for this reason.  Of course, looking at the landlord’s perspective, why risk it! 

Disability

When you have a disability, including mental health concerns, finding housing becomes even harder.  How do you find a place, which meets your unique needs, often on a fixed income?  With such a low vacancy rate, even less are assessable, and even less of those are affordable. 

Literacy/Language

Another barrier to finding safe housing is literacy and language.  What if you can’t read or speak English.  How do you go through ads, answer and ask questions etc… if you can’t follow the language.  Immigrants often have a very difficult time finding housing and often have little money, which adds to the problem. 

Discrimination

I’d love to say that I live in a country where no one cares about the colour of a person’s skin, or the fact that two men are renting a one-bedroom apartment.  But I don’t.  And the truth is, there are some groups of people who are going to be able to find housing a lot more easily then others.  For example, it took me a total of two apartment visits to find one I wanted this time.  And I got it.  Actually, I got both; it’s just that I only needed one, so I chose the one that best suited my needs.  Of course, I’m a white professional, and that does matter, even though it shouldn’t. 

 

Housing Part Two: Who needs housing?

I’m assuming that the majority of people reading this blog have some form of safe housing.  This is simply based on what I know about the demographics of those who comment.  However, I’m also going to make the assumption that at some point in our lives, all of us have had to, or will have to, look for housing.  Because the answer to who finds themselves in need of housing, is everyone.  It just happens that for some of us, it’s easier to find housing then for others. And so we’ll begin here, with situations that create that need.  This of course doesn’t cover all of them, but gives an example.

Apartments being turned into Condominiums

I don’t know what things are like in your part of the world, but where I live, apartment building after apartment building after apartment building is being bought, upgraded, turned into condos and it’s residents asked to vacate the premises.  While there are laws around timing of this, it is still a daily reality. 

Aging out

Perhaps it’s your parents telling you it’s time to find your own place, aging out of the foster care system or adolescent mental health system, perhaps you’re aging out of something else.  The point is an inevitability of life such as aging can play a huge impact on a persons need for housing. 

Separation, Divorce, Death of Spouse

When a family splits up a need for housing is often created for at least one of its members.  For example, a client of mine wound up homeless after he and his wife split up.  His wife and children stayed in their residence and he bounced from family member to family member until there was nowhere left for him. 

Lose or Change of employment/income

A person generally lives in housing for which the rent is paid by their income.  A change in income therefore can lead to a necessary change in housing.  Job loss by one member of the family, a decision to go back to school, the loss of benefits or other income bonuses can have a huge impact on the level of housing a family is able to afford. Income can also be lost due to disability, mental health concerns, long-term illness, addiction etc…

When everything goes wrong all at once

Maybe it starts with the car breaking down, then a family member becomes ill, rent increases, and then you lose your job.  Another client describes the lead up to being homeless as starting with one little thing and snowballing from there. 

Above Market Rent Increases

Where I live there is legislation governing how much rent can go up in a given year.  However, landlords can apply to increase rent over this if they can prove why they need to.  This can lead a person to no longer be able to afford their suite for no reason other then this, and it can happen to anyone. 

Accessibility

As people age, they develop the need for more assessable buildings.  Perhaps a building with an elevator instead of stairs.  Or maybe it’s a child who needs the assess ability.  Lots of reasons that you may need to look for a place with better access. 

 

Negative Symptoms of Schizophrenia

I had one of those eye opening moments the other day.  We had a client present with all the negative symptoms of schizophrenia, and virtually no positive ones.  Actually, rather then realizing that she had gone off her meds, we assumed she was on too many meds.  I would totally have bet on her anti psychotics being too high.  

When she came for her intake, she seemed like your average young adult female.  By the time she started her first class session she was freakishly unmoving, unspeaking, and seemingly uninterested.  When I say unmoving, I mean it was as if she became a part of the chair.  Always sitting perfectly straight though, never slouching.  Her eyes would choose a point, be it the front, the back, or the desk, and they would never move.  Her "creepy" coloured contacts, gave her an even more frightening look.  Her answers were all in yes or no form, with the most common one being "no".  Being her counselor, it fell to me to confront her.  

The first time I tried, I got no where.  She gave me some "nos" and then walked out.  So then two of us sat her down a different day.  At this point, she informed us she had stopped taking her medications after having a "bad" time with them.  We let her go without pushing her too hard, as she was honestly scaring both of us.  Our supervisor met with her and her father today... we'll see what happens.  

The point is though, assumptions are bad.  We all assumed she was over medicated and totally missed the fact that she was in fact off her meds.  Even though I knew she had a diagnosis of schizophrenia, and I know about negative symptoms, it didn't occur to me till yesterday that what we were seeing were symptoms not med reactions.  

Schizophrenia isn't just voices! 

The Service Eater

Most social workers have dealt with these clients.  The clients who have been to every program under the sun and hope that yours will give them that something they need, that one extra push etc…  The question is, what do you do with them? 

Something I’ve noticed, is that many of these clients have a very negative mental filter.  Despite the positive things which may be going on in their lives, they focus exclusively on the negative and seem unable to take the positive into account.  They often seem very genuine and earnest, often citing the bad experiences they’ve had with other social workers/programs.  And yet for some reason, they keep trying again. 

While some of them have tried and quit every program, there are some that are still IN every program.  I recently had a client who was seeing something like six different counselors at once, and wanted to join our program on top of that.  Despite all the counseling, he was definitely not mentally stable and I recommended we put a hold on his admittance.  I don’t think adding a seventh (or however many) service is actually going to do the client any good. 

The thing is though, no one program is going to be right for everyone, and sometimes what people need isn’t so much a program but someone who will stick with them no matter how many times they quit.  For example, if a client has a counselor who is willing to take them back no matter how many times they storm out and find a new counselor, maybe that continuity will help them to make progress.  It’s hard to know though.  Sometimes the thirtieth program is the answer, it’s the one that clicks, the one that works.

Maybe this thought doesn’t have a point? 

Borderline Personality Disorder

You know, I’d never really understood the hype about Borderline Personality Disorder; I kind of thought of it as an over diagnosed phenomenon with a huge stigma attached to it. 

I’m starting to get it. 

I have a client with a diagnosis of BPD.  I have one more who meets at least as many criteria.  And they really are hard clients to deal with.  If it wasn’t for the fact that we have a good supervisor, I think this client could have caused a huge stir around here very quickly with a couple accusatory emails she fired off yesterday and today.  Thankfully our supervisor realizes that we actually are doing what we’re suppose to do and has not sided with the client.  Because the staff involved have a good working relationship she has not been able to turn us against each other.  It’s a good thing.

All that being said, I still think it’s an overdosed phenomenon with a huge stigma attached to it. 

Currently, our staff is doing all the right things, and I hope that the client, and us, will be able to learn something from it.  Because we work as a team, we’ve decided to be consistent in the way we approach her and deal with her.  This virtually eliminates her success in playing us against each other.  Further, we had a community meeting with all her service providers (and her mother), and came up with a plan.  We’re sticking with the plan and trying to reinforce it with her.  This means redirecting accusations of “you’re not doing anything for me” to “did you get on the list for this class”? 

It also means ignoring some of her more exasturbating emails and reminding her to come in for her appointments.  This reinforces our team’s boundaries, because from what I’ve read, and what I’m observing, boundaries are going to be everything.  Fighting with her, is obviously unprofessional, but more over, it’s not going to work.  Accusing her of things is not going to help her or us in any way, shape, or form. 

deinstitutionalization

Let me start by saying that I realize I'm touching on a controversial subject.  I'm going to talk about it anyway.  

A few nights ago I was at a meeting about disability rights legislation.  Yay advocacy and policy development!  Anyway, at the end, for the "check out" (gotta love meetings run by social workers...) we had to share a barrier we thought was faced by the disabled community or that we were currently facing.  I talked about lack of adequate access to mental health care, some people talked about attitudes, others about accessability and employment, all the normal things.  What surprised me, was the number of people who talked about institutionalization and how important it was that we continue with deinstitutionalization.  

I'm not sure why it surprised me.  It's not exactly an unfamiliar concept for me, and for that matter it is something our government is currently working on.  Our newest Assertive Community Treatment team was set up to take referrals only from the long term mental health care facility, at least in it's initial stages.  In otherwords, it was designed to be intensive support for deinsitutionalization.  

The thing is, in my experience, institutionalization, in some way, is necessary, until we come up with better options for psychiatric treatment.  I spent eight months doing practicum in Assertive Community Treatment, the most intensive form of community mental health care my province has to offer.  The clients have a team of professionals and twenty four hour on call support.  They have daily contact, sometimes twice daily, observed meds and assistance with just about anything you could need assistance with.  Unfortunately, even with this very intensive level of support it was necessary to make two referrals to the long term care facility during my eight months.  Of course during that time we had many success stories as well.  

See the thing is, despite everything the team was doing, these clients simply could not be maintained in the community.  One woman was living in a rodent infested house with rotting floors, sleeping in a urine soaked bed, the house was in and out with drug dealers and the dirt was incredible.  She absolutely refused to take meds or to move.  Eventually the police had to remove her from the home and the public trustee made the decision to stop paying her rent.  The last time I saw her, she was doing okay in hospital, but certainly not well enough to live out again.  Another was so mentally ill and so drug addicted she jumped off a bridge, thankfully not too high up.  The courts didn't know what to do with her many crimminal charges and once release from jail or hospital she'd disappear for days at a time without taking her meds.  Because of her spinal injuries, she was referred to long term for her own safety.  

And then there are the forensic patients.  We have a special locked ward for them.  And seriously, I've been on the "worst" ward in the long term care facility.  The patients there are very, very mentally ill.  They are affected in ways that I cannot even begin to imagine.  Maybe with time, and patience and new treatments something will change, but until then... where will they go if their insitution is shut down?  

Finally there are the geriatric patients.  I've got news for you, schizophrenia doesn't end with middle adult hood, brain injuries don't magically heal.  And while we do have specialized homecare services, some clients just need more then that.  

So, i do agree with deinsitutionalization.  I want to be very clear about that.  I also don't agree with the institutions of the past, however, I want to make it very clear that there is a time and place in which long term psychiatric care facilities are necessary, and I don't think closing them all, especially without replacing them, will do the community a whole lot of good. 

What I'm reading this week: The culture of our disconent

Small, M (2006).  The culture of our discontent: Beyond the medical model of mental illness.  Washington, DC: Joseph Henry Press.

To start off with, let me say I really liked this book.  Meredith Small is an anthropologist who sets out to look at models of understanding mental illness in both Western Society and around them world.  I've never read much anthropology, so I'm not sure how things hold up from an anthropological stand point, but from a Social Work perspective the book was well written, concise and easy to understand.  To be honest, my favourite part about it was the length; not too long and not too short!

The stage is set in the introduction which describes the American Psychiatric Association's annual conference.  Small is surrounded by drug advertisements and drug representatives and says, "the ads addressed a cornucopia of negative human behaviors, and every symptom, syndrome or condition called for pharmaceutical treatment" (page 2).

The first chapter of the book looks at the impact of the medical model on mental illness, while the second chapter explores alternative models already present in Western Culture.  Third, Small looks at the biological basis for mental illness citing a variety of studies on monkeys (or non-human primates as the book describes them).  Moving on the book looks at how diet contributes to mental illness and how the slow change in diet of a country exposed to Western styles of eating can have mental illness increase in prevalence.

The middle of the book begins to look at things from the perspective of cultural anthropology.  Small discusses how mental illness is viewed in different cultures and the impact this has.  Next she discusses how some mental illnesses appear to be "culture bound" appearing only in certain populations living in more isolated parts of the world.  Small further discuss different treatments considered to be the norm in different parts of the world, placing importance on the link between the believed cause and the selected treatment (i.e. if possession causes mental illness then an exorcism is necessary).

The book ends without coming to a conclusion about which model is best, which is something I appreciated.  Small believes that what is universal, is that in all cultures treatment of mental illness is tied to hope.  "Sadness and despair might be the hallmarks of mental illness, but quite remarkably, every culture believes that something can always be done to bring relief" (page 4).

All in all, the book was a good read.  I learned a surprising amount from it without feeling that I was being overwhelmed by difficult to understand information.  The content flows together nicely with good transitions from one chapter to the next.  While I would recommend this book to anyone interested in learning more about Western thinking, I would especially recommend it to professionals who deal with a diverse population on a regular basis or with recent immigrants.  I would not however recommend this book to people who are looking for books about a very "anti" medical model of mental illness.  The book presents each view equally and it in no way raises one model above any other.

My new job

So, I've written tons and tons about the shelter over time, but I haven't yet written anything about my new job in terms of what I do, and what our program does.  The simple answer is that we provide job search support and employment support to people with mental illness who are unemployed or underemployed and whose mental illness is stable and does not currently prevent them from attaining and maintaining employment.  Okay, maybe that's not a "simple" answer, but it's an answer!  

Basically, here's how it works.  It's a small program with yearly renewable funding (meaning my job is only a for sure till March 31, 2010 last year the funding got doubled though, so I'm not tooooo worried).  People get referred by a variety of providers or self refer.  We do an intake, talk about them at the staff meeting, and then hopefully, they get into the program.  

First thing on the agenda is a four week class.  It meets for three hours a day and usually has 4-6 people in it.  They cover topics like stress management, social skills, assertiveness, conflict resolution, job interviews, resumes, cover letters, employement expectations, working with mental illness etc...  The classes are run much more like a counseling group then they are like a lecture, or at least the social worky classes are, I don't do employment classes so I'm really not sure about them.  During the four week class they check in with a counselor (me) or an employment support counselor once a week for ongoing stuff/issues with the class.  

After class, they get a "report" card and have a review meeting.  Most people "graduate" and get their certificate.  Then they move on to the job development phase.  In this phase our job developers work with them on finding the job (or the right training) that works for them.  It's really personalized attention, and can be really helpful.  The job developers also have ins with a lot of employers who are willing to hire our clients.  

Also following class, clients are given the option of working with a mental health counselor to talk about ongoing mental health issues, family issues, whatever.  There are two of us (like I said, small program) and we sort of split this up.  

Once a client has employment (and our current success rate is over 75%) they are hooked up with one of our employment support counselors.  This person connects with them weekly (at first) and the goal is to provide people with longer term support so they don't crash and burn in their new job.  

Finally, there is discharge.  We usually work with people for about a year, but of course there is variation.  If a person is in our program longer then a year with have to justify it to our funders, but it's usually not too hard.  

And so, that's my program in a nutshell!